Clinical efficacy analysis of flow diverter in the treatment of large unruptured intracranial aneurysms

Abstract

Objective To evaluate the safety and efficacy of flow diverter (FD) in the treatment of large (maximum diameter≥10 mm) unruptured intracranial aneurysms. Methods A total of 92 patients harboring 95 large unruptured intracranial aneurysms who underwent treatment with FD (Pipeline + Tubridge) at Department of Cerebrovascular Intervention, Zhengzhou University People's Hospital, Henan Provincial People's Hospital from February 2015 to July 2019 were enrolled into this retrospective study. The modified Rankin scale (mRS) was used to evaluate the clinical outcomes at follow-up, and O′Kelly-Marotta (OKM) grading scale was used to evaluate the occlusion of aneurysm. Multivariate logistic regression analysis was used to explore the influencing factors which could affect the aneurysm occlusion rate at 6-month follow-up. Results A total of 101 devices of FD were employed in 92 patients with 95 aneurysms, all of whom underwent successful operation. The incidence of neurological complications was 4.3% (4/92), which included 1 case of thromboembolic complication, 2 hemorrhagic events (1 death) and 1 case of postoperative irritability. Seventy-seven patients obtained clinical follow-up with a median of 12 (1-51) months. The mRS was 0 in 70 patients, 1 in 5, 2 in 1 and 3 in 1. There were 55 patients with 56 aneurysms who underwent the latest follow-up at a median of 6 (3-29) months post operation, and the complete occlusion (Grade D of OKM grading scale) rate was 71.4% (40/56), the in-stent stenosis rat was 7.1%(4/56). There were 52 patients with 53 aneurysms who obtained the 6-month imaging follow-up and the complete occlusion rate was 64.2% (34/53), the in-stent stenosis rat was 7.5%(4/53). Multivariate logistic regression showed that adjunctive coiling was the independent factor which affected the aneurysm occlusion rate at 6-month follow-up significantly (OR=8.98, 95% CI: 1.87-43.22, P=0.006). Conclusions The use of FD seems safe in the treatment of large unruptured intracranial aneurysms with a high procedure success rate. However, serious complications remain to be noted. Meanwhile, adjunctive coiling could promote the complete occlusion of intracranial aneurysms. Key words: Intracranial aneurysm; Treatment outcome; Postoperative complications; Large; Flow diverter